Provider Demographics
NPI:1407093594
Name:PIDO, JENNIFER SALAZAR (PT)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:SALAZAR
Last Name:PIDO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:214 W 5TH ST
Mailing Address - Street 2:STE D & E
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-2501
Mailing Address - Country:US
Mailing Address - Phone:417-782-2917
Mailing Address - Fax:417-782-7038
Practice Address - Street 1:14792 CATLIN TILTON RD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61834-5116
Practice Address - Country:US
Practice Address - Phone:217-443-6430
Practice Address - Fax:217-443-1558
Is Sole Proprietor?:No
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070015782225100000X
MO2006023687225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist